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Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

What makes these scores interesting is not that they’re just another set of rankings — those are pretty much everywhere — but that the researchers focused on EMR usability. As any clinician will tell you (and many have told me) despite years of evolution, EMRs are still a pain in the butt to use. And clearly, market forces are doing little to change this. Looking at where widely-used systems rate on usability is a refreshing look at a neglected issue.

To score the EMRs, researchers dug into EMR vendor testing reports from ONC. This makes sense. After all, though the agency doesn’t use this data for certification, the ONC does require EMR vendors to report on user-centered design processes they used for eight capabilities.

And while the ONC doesn’t base EMR certifications on usability, my gut feeling is that the data source is pretty reliable. I would tend to believe that given they’re talking to a certifying authority, vendors are less like to fudge these reports than any they’d prepare for potential customers.

According to the partners, Allscripts and McKesson were the highest-scoring EMR vendors, gaining 15 out of 15 points. eClinicalWorks was the lowest-scoring EMR, getting only 5 of 15 possible points. In-betweeners included Cerner and MEDITECH, which got 13 points each, and Epic, which got 9 points.

And here’s the criteria for the rankings:

User Centered Design Process: EMRs were rated on whether they had a user-centered design process, how many participants took part (15+ was best) and whether test participants had a clinical background.

Summative Testing Methodology: These ratings focused on how detailed the use cases relied upon by the testing were and whether usability measures focused on appropriate factors (effectiveness, efficiency and satisfaction).

Summative Testing Results: These measures focused on whether success rates for first-time users were 80% or more, and on how substantive descriptions of areas for improvement were.

Given the spotty results across the population of EMRs tested, it seems clear that usability hasn’t been a core concern of most vendors. (Yes, I know, some of you are saying, “Boy howdy, we knew that already!”)

Perhaps more importantly, though, it can be inferred that usability hasn’t been a priority for the health systems and practices investing in these products. After all, some of the so-so ratings, such as that for the Epic product, come from companies that have been in the market forever and have had the time to iterate a mature, usable product. If health systems were demanding that EMRs be easy to use, the scores would probably be higher.

Frankly, I can’t for the life of me understand why an organization would invest hundreds of millions of dollars (or even a billion) dollars in an EMR without being sure that clinicians can actually use it. After all, a good EMR experience can be very attractive to potential recruits as well as current clinicians. In fact, a study from early last year found that 79% of RNs see the hospital’s EMR as a one of the top 3 considerations in choosing where to work.

Maybe it’s an artifact of a prior era. In the past, perhaps the health systems investing in less-usable EMRs were just making the best of a shoddy situation. But I don’t think that excuse plays anymore. I believe more providers need to adopt frameworks like this one, and apply them rigorously.

Look, I know that EMR investment is a complex dance. And obviously, notions of usability will continue to evolve as EMRs involve — so perhaps it can’t be the top priority for every buyer. But it’s more than time for health organizations to take usability seriously.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I think most of us reading HealthcareScene.com blogs like this one would agree that for EMRs to become more usable, the process of developing them will have to change. Specifically, everyone seems to agree that if vendors and physicians don’t work together on usability, we’ll end up with with system after system that nobody wants.

But what about patients? Do they have a role in making sure EMRs are usable? According to Jon Mertz, the answer is a definite yes. As Mertz sees it, it’s not good enough for vendors and physicians to talk shop to one another — patients will have to be part of the conversation. I think he makes a lot of sense.

Talking with EMR vendors is a good way for physicians to get more of what they want, but it’s not enough, Mertz argues, I think quite persuasively. It’s also important for physicians to ask patients want to see in an EMR, especially so given that patients will eventually have access to all of that information. “Patients add an essential perspective to how an [EMR] should be used,” Mertz writes. “It is a system to serve them and their care.”

Vendors should also be talking to patients as well as physicians, Mertz suggests. “Even though physicians, clinicians, and administrative personnel are the primary users of an EHR, their solutions benefit patients, too. Information in an EHR will be viewed and carried forward by patients, so they can provide a valuable perspective on usability.”

The final step in this cycle is to develop a patient base which actively uses EMR data and is quite willing to offer feedback on how the process is working. Specifically, they need to be capable of letting hospitals, physicians and other providers know how their access to data is working, especially if the form they’re getting in doesn’t serve their needs.

I really appreciated Mertz’s take on getting patients involved in the EMR usability process. It’s a point that doesn’t get made often enough — and will definitely need to be talked up more in the future. After all, without patients feeling comfortable with their data, the ultimate goals of Meaningful Use aren’t attainable.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

If you’re like me, you’ll probably be a bit surprised (pleasantly) by the following video, which can be found embedded in an equally interesting blog post on EMR feature-creep or “featuritis” by Dr. Charles Webster. (I would have shared the video here but it’s only available on Dr. Webster’s site.)

In it, the ever-insightful Dr. Webster details how a peds practice has gotten to the point where a routine encounter takes 37 seconds to chart using the practice’s pediatrics-specialized EMR, as follows:

1:08

I open the chart

1:13

Chart my physical exam, my pharyngitis exam

1:19

Chose my diagnosis of strep pharyngitis

1:25

Make my treatment duracef and follow up in 3 days

1:31

Write my prescription

1:33

Edit my follow up if necessary

1:37

Have created a beautiful chart

1:42

Check my billing

1:44

And I’m finished

That may sound extreme, but it’s not, he says. “I’ve looked at timed studies of our current physicians’ charting at pediatrics or family practice, and the average chart for a sick visit is 28 seconds,” he notes.

As if that wasn’t sensational enough for an audience expecting EMRs to make everything tougher, he had more to share.
“In reality, with a finger or a stylus you can do this in about a third the time,” Dr. Webster told them. In this case, that would mean 17 clicks in 12 seconds, but people can generally tap their finger at that pace with little trouble, he says. Not such a big deal.

That being said, it seems likely that going forward, doctors will need to better develop the cognitive motor skills of musicians — the ability to step up eye-hand coordination to be sure — if they want the best results out of their systems. Dr. Webster says he’s planning a future post which critiques EMR data and order entry from the point of view of psychological models of musical cognition, learning, and motor skill. I think I’ll want to catch that one!